AB40-ASA1,595,163
49.45 (52) (a) 1. Beginning on January 1, 2003If the department provides the 4notice under par. (c) selecting the payment procedure in this paragraph, the 5department may, from the appropriation account under s. 20.435 (7) (b), make 6Medical Assistance payment adjustments to county departments under s. 46.215, 746.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 8(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and 9(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for 10services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating 11in the early intervention program under s. 51.44. Payment adjustments under this 12subsectionparagraph shall include the state share of the payments. The total of any 13payment adjustments under this subsectionparagraph and Medical Assistance 14payments made from appropriation accounts under s. 20.435 (4) (b),
(gm), (o), and 15(w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) 16(A).

AB40-ASA1,595,2118
49.45 (52) (a) 2. The department may require a county department or local 19health department to submit a certified cost report that meets the requirements of 20the federal department of health and human services for covered services described 21in subd. 1.

AB40-ASA1,596,107
2. For services described under subd. 1., the department shall base the amount 8of a claim for federal medical assistance funds on certified cost reports submitted by 9county departments under subd. 1. to the extent the reports comply with federal 10requirements.

AB40-ASA1,596,1311
3. The department shall pay county departments a percentage of the federal 12funds claimed under subd. 2. for services described under subd. 1., which percentage 13is established in the most recent biennial budget.

AB40-ASA1,596,1714
4. The department may pay a local health department, as defined in s. 250.01 15(4), that submits certified cost reports for services described under subd. 1. a 16percentage of the federal funds claimed for those services, which percentage is 17established in the most recent biennial budget.

AB40-ASA1,596,2319
49.45 (52) (c) The department shall select a payment procedure under either 20par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The 21department shall notify each county department and local health department, as 22applicable, of the selected payment procedure before the date on which payment for 23services is made under that selected or newly selected procedure.

AB40-ASA1,597,4149.45 (53)Payments for certain services. Beginning on January 1, 2003, the 2department may, from the appropriation account under s. 20.435 (7) (b), make 3Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a) 44. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.

AB40-ASA1,597,1613
49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise 14provided by the department by a policy created under s. 49.45 (2m) (c), the 15department shall audit and pay allowable charges to certified providers for medical 16assistance on behalf of recipients for the following federally mandated benefits:

AB40-ASA1,597,2219
49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise 20provided by the department by a policy created under s. 49.45 (2m) (c), the 21department shall audit and pay allowable charges to certified providers for medical 22assistance on behalf of recipients for the following federally mandated benefits:

AB40-ASA1,598,4149.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless 2otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the 3department shall audit and pay allowable charges to certified providers for medical 4assistance on behalf of recipients for the following services:

AB40-ASA1,598,107
49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless 8otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the 9department shall audit and pay allowable charges to certified providers for medical 10assistance on behalf of recipients for the following services:

AB40-ASA1,599,212
49.46 (2) (c) 2. For an individual who is entitled to coverage under partPart13A of medicareMedicare, entitled to coverage under partPart B of
medicareMedicare, 14meets the eligibility criteria under sub. (1), and meets the limitation on income under 15subd. 6., medical assistanceMedical Assistance shall include payment of the 16deductible and coinsurance portions of medicareMedicare services under 42 USC 171395 to 1395zzwhichthat are not paid under 42 USC 1395 to 1395zz, including those 18medicareMedicare services that are not included in the approved state plan for 19services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; 20the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late 21enrollment penalty, if applicable, for premiums under partPart A of medicare22Medicare. Payment of coinsurance for a service under
partPart B of medicare23Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for 24outpatient hospital services,and payment of deductibles and coinsurance for 25inpatient hospital services under Part A of Medicare may not exceed the allowable 1charge for the service under medical assistanceMedical Assistance minus the 2medicareMedicare payment.

AB40-ASA1,599,154
49.46 (2) (c) 3. For an individual who is only entitled to coverage under part5Part A of medicareMedicare, meets the eligibility criteria under sub. (1), and meets 6the limitation on income under subd. 6., medical assistanceMedical Assistance shall 7include payment of the deductible and coinsurance portions of medicareMedicare8services under 42 USC 1395 to 1395iwhichthat are not paid under 42 USC 1395 to 91395i, including those medicareMedicare services that are not included in the 10approved state plan for services under 42 USC 1396; the monthly premiums, if 11applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, 12for premiums under partPart A of
medicareMedicare. Payment of deductibles and 13coinsurance for inpatient hospital services under Part A of Medicare may not exceed 14the allowable charge for the service under Medical Assistance minus the Medicare 15payment.

AB40-ASA1,600,517
49.46 (2) (c) 4. For an individual who is entitled to coverage under partPart18A of medicareMedicare, entitled to coverage under partPart B of
medicareMedicare,19and meets the eligibility criteria for medical assistanceMedical Assistance under 20sub. (1), but does not meet the limitation on income under subd. 6.,
medical 21assistanceMedical Assistance shall include payment of the deductible and 22coinsurance portions of medicareMedicare services under 42 USC 1395 to 1395zz23whichthat are not paid under 42 USC 1395 to 1395zz, including those medicare24Medicare services that are not included in the approved state plan for services under 2542 USC 1396. Payment of coinsurance for a service under partPart B of medicare1Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for 2outpatient hospital services,and payment of deductibles and coinsurance for 3inpatient hospital services under Part A of Medicare may not exceed the allowable 4charge for the service under medical assistanceMedical Assistance minus the 5medicareMedicare payment.

AB40-ASA1,600,167
49.46 (2) (c) 5. For an individual who is only entitled to coverage under part8Part A of medicareMedicare and meets the eligibility criteria for medical assistance9Medical Assistance under sub. (1), but does not meet the limitation on income under 10subd. 6., medical assistanceMedical Assistance shall include payment of the 11deductible and coinsurance portions of medicareMedicare services under 42 USC 121395 to 1395iwhichthat are not paid under 42 USC 1395 to 1395i, including those 13medicareMedicare services that are not included in the approved state plan for 14services under 42 USC 1396. Payment of deductibles and coinsurance for inpatient 15hospital services under Part A of Medicare may not exceed the allowable charge for 16the service under Medical Assistance minus the Medicare payment.

AB40-ASA1,601,218
49.46 (2) (c) 5m. For an individual who is only entitled to coverage under part19Part B of medicareMedicare and meets the eligibility criteria under sub. (1), but does 20not meet the limitation on income under subd. 6., medical assistanceMedical 21Assistance shall include payment of the deductible and coinsurance portions of 22medicareMedicare services under 42 USC 1395j to 1395w, including those medicare23Medicare services that are not included in the approved state plan for services under 2442 USC 1396. Payment of coinsurance for a service under partPart B of medicare, 25other than payment of coinsurance for outpatient hospital services,
Medicare may 1not exceed the allowable charge for the service under medical assistanceMedical 2Assistance minus the medicareMedicare payment.

AB40-ASA1,601,105
49.465 (2) (intro.) Unless otherwise provided by the department by a policy 6created under s. 49.45 (2m) (c), a pregnant woman is eligible for medical assistance 7benefits, as provided under sub. (3), during the period beginning on the day on which 8a qualified provider determines, on the basis of preliminary information, that the 9woman's family income does not exceed the highest level for eligibility for benefits 10under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:

AB40-ASA1,601,1813
49.465 (2) (intro.) Unless otherwise provided by the department by a policy 14created under s. 49.45 (2m) (c), a A pregnant woman is eligible for medical assistance 15benefits, as provided under sub. (3), during the period beginning on the day on which 16a qualified provider determines, on the basis of preliminary information, that the 17woman's family income does not exceed the highest level for eligibility for benefits 18under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:

AB40-ASA1,602,1120
49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage 21under partPart A of medicareMedicare, entitled to coverage under partPart B of 22medicareMedicare, and who does not meet the eligibility criteria for medical 23assistanceMedical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but 24meets the limitations on income and resources under par. (d), medical assistance25Medical Assistance shall pay the deductible and coinsurance portions of medicare1Medicare services under 42 USC 1395 to 1395zz
whichthat are not paid under 42 2USC 1395 to 1395zz, including those medicareMedicare services that are not 3included in the approved state plan for services under 42 USC 1396; the monthly 4premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 542 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums 6under partPart A of medicareMedicare. Payment of coinsurance for a service under 7partPart B of medicareMedicare under 42 USC 1395j to 1395w, other than payment 8of coinsurance for outpatient hospital services,and payment of deductibles and 9coinsurance for inpatient hospital services under Part A of Medicare may not exceed 10the allowable charge for the service under medical assistanceMedical Assistance11minus the medicareMedicare payment.

AB40-ASA1,602,2513
49.468 (1) (c) For an elderly or disabled individual who is only entitled to 14coverage under partPart A of medicareMedicare and who does not meet the 15eligibility criteria for medical assistanceMedical Assistance under s. 49.46 (1), 1649.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under 17par. (d), medical assistanceMedical Assistance shall pay the deductible and 18coinsurance portions of medicareMedicare services under 42 USC 1395 to 1395i19whichthat are not paid under 42 USC 1395 to 1395i, including those medicare20Medicare services that are not included in the approved state plan for services under 2142 USC 1396; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and 22the late enrollment penalty for premiums under part
Part A of medicareMedicare, 23if applicable. Payment of deductibles and coinsurance for inpatient hospital services 24under Part A of Medicare may not exceed the allowable charge for the service under 25Medical Assistance minus the Medicare payment.

AB40-ASA1,603,63
49.47 (4) (a) (intro.) Unless otherwise provided by the department by a policy 4created under s. 49.45 (2m) (c), any individual who meets the limitations on income 5and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) shall 6be eligible for medical assistance under this section if such individual is:

AB40-ASA1,603,129
49.47 (4) (a) (intro.) Unless otherwise provided by the department by a policy 10created under s. 49.45 (2m) (c), anyAny individual who meets the limitations on 11income and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) 12shall be eligible for medical assistance under this section if such individual is:

AB40-ASA1,604,214
49.47 (4) (i) 1. The department shall request a waiver from the secretary of the 15federal department of health and human services to permit the application of subd. 162. The waiver shall request approval to implement the waiver on a statewide basis, 17unless the department of health services determines that statewide implementation 18of the waiver would present an obstacle to the approval of the waiver by the secretary 19of the federal department of health and human services, in which case the waiver 20shall request approval to implement the waiver in 48 pilot counties to be selected by 21the department of health services. Within 30 days after August 12, 1993, the 22department of regulation and licensingsafety and professional services shall notify23funeral directors licensed under ch. 445, cemetery associations, as defined in s. 24157.061 (1r), and cemetery authorities, as defined in s. 157.061 (2), of the terms of 25the waiver required to be requested under this subdivision. If the waiver is approved 1by the secretary of the federal department of health and human services and if the 2waiver remains in effect, subd. 2. shall apply.

AB40-ASA1,604,124
49.47 (4) (k) Notwithstanding par. (b) 3. and s. 445.125 (1) (a), no later than 60 5days after the effective date of this paragraph .... [LRB inserts date], the department 6shall seek approval from the federal Centers for Medicare and Medicaid Services to 7permit friends and family members of any individual receiving medical assistance 8under this section to contribute funds to an irrevocable burial trust for the 9individual, up to a total irrevocable trust amount of $4,500, without the individual 10losing eligibility for medical assistance under this section. If the federal Centers for 11Medicare and Medicaid Services approves the request, the department shall 12implement the change under this section within 60 days after receiving approval.

AB40-ASA1,604,2119
49.47 (5) (a) When there is reasonable ground for belief that an applicant may 20not be eligible or that the beneficiary may have received benefits to which the 21beneficiary is not entitled.

AB40-ASA1,605,324
49.47 (5) (c) Any time determined by the department by a policy created under 25s. 49.45 (2m) (c) to determine eligibility or to reevaluate continuing eligibility, except 1that if federal law allows a reevaluation of eligibility more frequently than every 12 2months and if there is no conflicting provision of state law, the department is not 3required to create a policy to reevaluate eligibility under this section.

AB40-ASA1,606,617
49.47 (6) (a) 6. b. An individual who is entitled to coverage under partPart A 18of medicareMedicare, entitled to coverage under partPart B of medicareMedicare, 19meets the eligibility criteria under sub. (4) (a), and meets the income limitation, the 20deductible and coinsurance portions of medicareMedicare services under 42 USC 211395 to 1395zzwhichthat are not paid under 42 USC 1395 to 1395zz, including those 22medicareMedicare services that are not included in the approved state plan for 23services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; 24the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late 25enrollment penalty, if applicable, for premiums under partPart A of medicare1Medicare. Payment of coinsurance for a service under partPart B of medicare2Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for 3outpatient hospital services,and payment of deductibles and coinsurance for 4inpatient hospital services under Part A of Medicare may not exceed the allowable 5charge for the service under medical assistanceMedical Assistance minus the 6medicareMedicare payment.

AB40-ASA1,606,188
49.47 (6) (a) 6. c. An individual who is only entitled to coverage under partPart9A of medicareMedicare, meets the eligibility criteria under sub. (4) (a), and meets 10the income limitation, the deductible and coinsurance portions of
medicareMedicare11services under 42 USC 1395 to 1395iwhichthat are not paid under 42 USC 1395 to 121395i, including those medicareMedicare services that are not included in the 13approved state plan for services under 42 USC 1396; the monthly premiums, if 14applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, 15for premiums under partPart A of
medicareMedicare. Payment of deductibles and 16coinsurance for inpatient hospital services under Part A of Medicare may not exceed 17the allowable charge for the service under Medical Assistance minus the Medicare 18payment.

AB40-ASA1,607,620
49.47 (6) (a) 6. d. An individual who is entitled to coverage under partPart A 21of medicareMedicare, entitled to coverage under partPart B of medicareMedicare,22and meets the eligibility criteria for medical assistanceMedical Assistance under 23sub. (4) (a), but does not meet the income limitation, the deductible and coinsurance 24portions of medicareMedicare services under 42 USC 1395 to 1395zzwhichthat are 25not paid under 42 USC 1395 to 1395zz, including those medicareMedicare services 1that are not included in the approved state plan for services under 42 USC 1396. 2Payment of coinsurance for a service under partPart B of medicareMedicare under 342 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital 4services,and payment of deductibles and coinsurance for inpatient hospital services 5under Part A of Medicare may not exceed the allowable charge for the service under 6medical assistanceMedical Assistance minus the medicareMedicare payment.

AB40-ASA1,607,158
49.47 (6) (a) 6. e. An individual who is only entitled to coverage under partPart9A of medicareMedicare and meets the eligibility criteria for medical assistance10Medical Assistance under sub. (4) (a), but does not meet the income limitation, the 11deductible and coinsurance portions of medicareMedicare services under 42 USC 121395 to 1395i, including those services that are not included in the approved state 13plan for services under 42 USC 1396. Payment of deductibles and coinsurance for 14inpatient hospital services under Part A of Medicare may not exceed the allowable 15charge for the service under Medical Assistance minus the Medicare payment.

AB40-ASA1,608,217
49.47 (6) (a) 6. f. For an individual who is only entitled to coverage under part18Part B of medicareMedicare and meets the eligibility criteria under sub. (4), but does 19not meet the income limitation, medical assistance
Medical Assistance shall include 20payment of the deductible and coinsurance portions of medicareMedicare services 21under 42 USC 1395j to 1395w, including those medicare
Medicare services that are 22not included in the approved state plan for services under 42 USC 1396. Payment 23of coinsurance for a service under partPart B of medicare, other than payment of 24coinsurance for outpatient hospital services,Medicare may not exceed the allowable 1charge for the service under medical assistanceMedical Assistance minus the 2medicareMedicare payment.

AB40-ASA1,608,75
49.471 (13)Applicability. If the department creates a policy under s. 49.45 6(2m) (c), subs. (4), (5), (6), (7), (8), (10), and (11) do not apply to the extent that those 7subsections conflict with the policy.

AB40-ASA1, s. 1461h8Section 1461h. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act 9.... (this act), is repealed.

AB40-ASA1,608,1512
49.472 (3)Eligibility. (intro.) Except as provided in sub. (6) (a) and unless 13otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an 14individual is eligible for and shall receive medical assistance under this section if all 15of the following conditions are met:

AB40-ASA1,608,2118
49.472 (3)Eligibility. (intro.) Except as provided in sub. (6) (a) and unless 19otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an 20individual is eligible for and shall receive medical assistance under this section if all 21of the following conditions are met:

AB40-ASA1,609,324
49.472 (4) (b) (intro.) The department may waive monthly premiums that are 25calculated to be below $10 per month. Unless otherwise provided by the department 1by a policy created under s. 49.45 (2m) (c), the department may not assess a monthly 2premium for any individual whose income level, after adding the individual's earned 3income and unearned income, is below 150% of the poverty line.

AB40-ASA1,609,106
49.472 (4) (b) (intro.) The department may waive monthly premiums that are 7calculated to be below $10 per month. Unless otherwise provided by the department 8by a policy created under s. 49.45 (2m) (c), theThe department may not assess a 9monthly premium for any individual whose income level, after adding the 10individual's earned income and unearned income, is below 150% of the poverty line.

AB40-ASA1,609,1712
49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account13accounts under s. 20.435 (4) (b), (gm), or (w), the department shall, on the part of an 14individual who is eligible for medical assistance under sub. (3), pay premiums for or 15purchase individual coverage offered by the individual's employer if the department 16determines that paying the premiums for or purchasing the coverage will not be more 17costly than providing medical assistance.

AB40-ASA1,609,2219
49.472 (6) (b) If federal financial participation is available, from the 20appropriation accountaccounts under s. 20.435 (4) (b), (gm), or (w), the department 21may pay medicare Part A and Part B premiums for individuals who are eligible for 22medicare and for medical assistance under sub. (3).

AB40-ASA1,610,5149.473 (2) (intro.) Unless otherwise provided by the department by a policy 2created under s. 49.45 (2m) (c), a woman is eligible for medical assistance as provided 3under sub. (5) if, after applying to the department or a county department, the 4department or a county department determines that she meets all of the following 5requirements: